Hyperprolactinemic recurrent miscarriage and results of randomized bromocriptine treatment trials

Objective: To evaluate hyperprolactinemia in the pathogenesis of recurrent spontaneous abortion. Design: Randomized trial. Setting: Miscarriage clinic, Yokohama City University Hospital, Yokohama, Japan. Patient(s): From a group of 352 women with recurrent spontaneous abortion, we identified 64 patients with a prolactin disorder that was not associated with any other etiologic abnormalities, including ovarian or endocrinologic disturbances such as luteal phase dysfunction, polycystic ovaries, hypersecretion of LH, galactorrhea, or thyroid hormone disorders. Intervention(s): Restoration of prolactin levels with bromocriptine. Main Outcome Measure(s): Successful pregnancy (live birth). Result(s): The percentage of successful pregnancies was higher in the bromocriptine-treated group than in the group that was not treated with bromocriptine (85.7% versus 52.4%, P < .05). Serum prolactin levels during early pregnancy (5–10 weeks of gestation) were significantly higher in patients who miscarried (31.8–55.3 ng/mL) than in patients whose pregnancies were successful (4.6–15.5 ng/mL, P < .01 or P < .05). Conclusion(s): Appropriate circulating levels of prolactin may play an important role in maintaining early pregnancy, especially in cases of hyperprolactinemic recurrent miscarriage.